Hearing Aids for SLPs

D R . R E B E C C A L O W E A U D , C C C - A
U N I V E R S I T Y O F M I S S I S S I P P I
HEARING AIDS:
TRAINING FOR
SPEECH-LANGUAGE
PATHOLOGISTS

WHY THIS TRAINING?
• Understanding the proper functioning of a hearing aid is key
to knowing how to troubleshoot the aid when it is
malfunctioning.
• Woodford (1987) proposed that the speech-language
pathologist was the key personnel in school systems to check
the hearing aids to ensure proper functioning.
• To do so, the SLP must have the knowledge and skills to carry
out this task.
• Also, the SLP is often asked to perform teacher in-services on
various topics related to speech, language, and hearing.
• The purpose of this power point is to train and equip the SLP
with the knowledge needed to troubleshoot hearing aids. It
also provides the SLP with a “ready-made” in-service training
on troubleshooting hearing aids. The SLP has permission to use
this power point and make any changes necessary to assist
them in giving in-services on hearing aids.

BASIC FACTS ABOUT HEARING AIDS
• Hearing aids are devices designed to amplify
sound from the environment in order to provide
the wearer with better access to the world.
• Candidacy for hearing aids should not be
based on specific thresholds, but whether the
person’s hearing loss that places him/her at a
disadvantage during daily life activities (Bentler,
1993).
• In other words, children with a minimal loss may
be at an academic disadvantage and
therefore be a candidate for a hearing aid or
other type of amplification device.

HEARING AIDS CONTINUED
• Hearing aids are specific to the
person and his/her hearing loss.
• Generally binaural
• Behind-the-ear models most often
used with children due to need for
FM systems, and constantly
changing ear canal size.

MYTHS ABOUT HEARING AIDS
Hearing aids are the perfect solution
Hearing aids restore perfect hearing
Once the child receives hearing aids,
he can hear like his peers
Once the child receives hearing aids,
he will start talking immediately

ERADICATING THAT MYTH -
CONCEPT OF AUDITORY AGE
• Auditory age/hearing age are terms
used to put the language
development of a child in perspective
• The child’s hearing age begins once
he has access to the sounds of his
world
• Normal infants do not speak the day
they are born – normally they say their
first words after ~ a year
• We cannot expect the hard-of-hearing
child to speak “right away”.

HOW TO KNOW WHEN A HEARING AID
IS MALFUNCTIONING
• Children may produce symptoms of hearing loss not
previously seen in therapy
• The child does not respond to the LING sound
check as he/she did previously
• The Listening Check of the Hearing Aid prior to
therapy indicates a problem

SYMPTOMS OF HEARING LOSS IN
CHILDREN (ASHA, 2011)
• The child is inconsistently responding to sound.
• Language and speech development is delayed.
• Speech is unclear.
• Volume is turned up high on electronic equipment
(radio, TV, CD player, etc.).
• Your child does not follow directions.
• Your child often says, "Huh?”
• Your child does not respond when called.

SYMPTOMS WHEN CHILDREN WHO HAVE
HA’S/CI NEED REPROGRAMMING
• Poor/unusual voice quality
• Relies on vision for input
• Poor speech perception
• Inappropriate/unusual consonant development
• Consistent omission or substitution of specific
phonemes
• Speech production not improving
• Speech perception poor in competing noise
• The child does not respond as he had previously to
the LING sound check
(Hewitt, Madell & Rotfleisch, 2011)

LING SOUNDS
• The goal of amplification is to make ALL speech sounds audible
to the child
• The LING sound check is a listening test that is often used with
children who wear hearing aids/CI.
• This test is comprised of 6 sounds that represent the entire speech
spectrum from low pitch sounds to high pitch sounds. The 7th
stimuli in the LING sound test is “silence”.
• If the aids/CI is functioning properly, the child should be able to
repeat these sounds
• Have client repeat LING sounds without visual input (stand behind
them/use speech hoop)
• Do this with each ear individually and then together BEFORE
THERAPY OR A SPEECH EVALUATION

THE LING SOUNDS
• The 7 LING SOUNDS:
• AHHHH
• OOOO
• EEEEEE
• SSSSSS
• SSHHHHH
• MMMM
• Silence

IMPORTANCE OF USING LING SOUNDS TO
IDENTIFY NEED FOR REPROGRAMMING
• Allows a quick and easy way to check that a
person is able to detect and identify sounds within
the speech range.
• Provides information regarding an individual's
distance of hearing or earshot.
• Results ensure that hearing aid and/or CI is
functioning properly and individual is receiving
maximum benefit from his/her device
• Represents all frequencies across the speech
banana
(Archer & Crosby-Quinatoa, 2009)

WHEN TO DO THE LING SOUND CHECK
• The teacher should do the LING sound check at the
beginning of class each day to ensure the child has
access to all the speech she will use in class.
• The SLP should do the LING sound check at the
beginning of therapy each day or the beginning of
an evaluation.
• If the child cannot accurately produce the LING
sounds as well as he/she was able to before, a
listening check and troubleshooting of the hearing
aids should occur.
• If the hearing aid sounds fine, then contact the
audiologist to see if a referral is warranted.

WHAT SLPS SHOULD KNOW ABOUT
HEARING AIDS
• Different types/styles
• Basic components
• Tools needed for listening checks/troubleshooting
of hearing aids
• How to perform a listening check
• How to troubleshoot hearing aids

SIZES AND STYLES OF HA’S
• Find the perfect fit for the client’s
lifestyle and hearing!

FOUR STYLES OF HA’S
• Behind-the-ear hearing aid (BTE)
• In-the-ear hearing aid (ITE),
• In-the-canal hearing aid (ITC),
• Completely-in-the-canal hearing aid (CIC)
(Mueller, Johnson, & Carter, 2007).
• Each style is a different size and offers different
features. The style selected is based upon several
client factors which include age, degree of hearing
loss, needs of client, and the need for various
controls.

BTE-BEHIND THE EAR
• The BTE is worn over the ear and is coupled with
tubing to an ear mold that fits inside the ear canal.
• BTEs are primarily fit on children with growing ear
canals so that the ear mold can be changed as the
ear grows.
• BTEs are also fit on individuals with severe-to-
profound losses because they can be powerful and
can couple to other assistive devices (Mueller et al,
2007).

ITE-IN THE EAR
• The ITE comes in graded sizes ranging from a full-
shell size down to a half-shell size.
• Generally, the bigger the ITE, the more gain it offers
(Mueller et al, 2007).
• The ITE is easier to insert and remove than the BTE
and may be more appropriate for people with
dexterity issues.

ITC-IN THE CANAL
• The ITC takes up approximately one-quarter of the
concha bowl, but may not offer as much power
and or as many options as the ITE
• However, it may be appropriate for those who
desire a smaller aid due to cosmetic concerns,
those who have less profound hearing losses,
and/or those with dexterity problems (Mueller et al,
2007).

CIC-COMPLETELY IN THE CANAL
• The CIC is the smallest hearing aid and takes up
only the canal portion of the ear.
• It is popular with those clients who have cosmetic
concerns regarding their hearing aids (Mueller et al,
2007).

COMPONENTS OF A HEARING AIDS
• Components of hearing aids
• How hearing aids function

Microphone (c)
The microphone picks up sounds from the
air and convert them into electrical signals.
Amplifier (d)
The amplifier increases the intensity of the
signals from the microphone. Filters modify
the sounds so that only sounds which are
relevant for the person are amplified.
‘Receiver' (loudspeaker) (g)
The third basic component is the receiver
(loudspeaker). It converts electrical signals
into acoustic signals, which the person then
hears.
These three components exist in all hearing
aids.
Small computer (Digital)
Furthermore, in digital hearing aids a small
computer can be programmed to
manipulate the signals to fit the hearing loss
of the individual hearing-impaired person.
Battery – power source

• Sound waves enter the hearing aid through the
microphone. The microphone picks up sounds from the
environment.
• The microphone converts the sound waves into an
electrical signal.
• The converted energy is sent to the amplifier.
• The amplifier increases the strength of the electrical
signal.
• A smaller loudspeaker called a receiver functions to
convert the amplified signals back into sound waves.
• The amplified sound is channeled from the receiver
directly to the ear canal.
• The battery provides electrical energy to power the
hearing aid and enable the amplification process to
occur.

HEARING AIDS
• Though the basic components are the same for the
various styles of hearing aids and some of the
problems that can occur are also the same; the
solutions to these problems may vary depending on
the style of hearing aid.
• Some of the more common problems with hearing
aids are feedback (whistling), an intermittent signal,
no signal, and a distorted signal.

TOOLS SLP’S SHOULD HAVE HANDY
FOR CARE OF HEARING AIDS
• Stethoset
• Battery tester
• Extra batteries
• Dri-Aid kit
• Brush, wire loop
• Ear Mold Blower
• Otoferm
• An audiologist can help you put a kit together
• Some Hearing Aid companies supply kits

PERFORMING THE
LISTENING CHECK

EASY TIPS IN ORDER TO PERFORM A
LISTENING CHECK
• How do you do it?
• Before you put the aid on the child, listen to the aid yourself.
• Attach the hearing aid/ear mold to the end of stethoset
open tube
• Make sure hearing aid is on
• Rotate the volume wheel up and down
• Rotate through programs
• Talk into hearing aid and listen to the aid
• Use the Ling Sounds (ooo, aahh, eee, sss, shhh, mmm)
• Count
• Use normal speech “test, test”

LISTENING CHECK
• What are you listening for?
• Dead hearing aid
• Distortion
• Crackling
• Intermittence/cutting in or out
• Weak
• Clarity
• Feedback
• Buzzing

HOW TO TROUBLESHOOT HEARING AIDS
•Troubleshooting ITE/ITC/CICs
•Troubleshooting BTEs

TROUBLESHOOTING
• The SLP faced with a non-functioning hearing aid
could consult the chart and start applying the
solutions beginning with the most plausible solution
first.
• Troubleshooting requires a visual inspection and
listening check of the hearing aid. It helps to use an
otoscope for the visual inspection.
• One should look at the receiver tubing for wax and
should inspect the microphone for dirt.
• If wax or dirt is seen, one should gently brush these
parts of the hearing aid using a small brush made
for this purpose.

PROCEDURES FOR TROUBLESHOOTING
(ITE, ITC, CIC)
• The Following Charts have been slightly modified
from that found in Wayner, D.S. (2004). What every
SLP needs to know about hearing: Fingertip Facts.
Latham, NY: Hearing Again, Inc.

(ITE, ITC, CIC)
Problems Causes Solutions
“Dead” Hearing
aid (no sound at
all)
Battery is weak
Battery is in hearing aid
incorrectly
Wrong type of battery
Opening in nib is plugged
with wax
Put in new battery
Put battery in aid correctly
Replace with right type of
battery
Remove wax with a wax brush
and clean vent with a pipe
cleaner-never use a tooth
pick

(ITE, ITC, CIC)
Problem Causes Solutions
Distortion
of Sound
Battery is almost dead.
Opening in nib is plugged
Volume control is turned to
full-on
Microphone opening is dirty
or covered.
Replace battery
Remove wax or dirt with a
wax brush
Turn down volume control to
correct volume setting
Remove dirt, food etc from
mic with care using wax
brush and be sure mic is left
uncovered. (Sometimes
cleaning must be done by
the audiologist.)

(ITE, ITC, CIC)
Intermittent sound
(aid goes on and
off)
Battery is almost
dead.
Bad volume control.
Moisture in aid
Put in a new battery
Check with
audiologist
Use dehumidifier
or the dri-aid kit
overnight. If
problem persists
check with
audiologist.

(ITE, ITC, CIC)
Feedback
(whistling)
Hearing aid is not
put into ear
correctly
Hearing aid does
not fit well
Volume control is
turned to high
Internal feedback
inside the
hearing aid
Put hearing aid
carefully into ear
so it fits snugly.
Check with
audiologist
Turn down volume,
but not below its
normal setting.
Check with
audiologist

THE BTE HEARING AID
• The Following Charts have been slightly modified
from that found in Wayner, D.S. (2004). What every
SLP needs to know about hearing: Fingertip Facts.
Latham, NY: Hearing Again, Inc.

TROUBLESHOOTING FOR BTE
“Dead”
Hearing aid
(no sound at
all)
Battery is dead
Battery is in hearing aid
incorrectly
Wrong type of battery
Battery contacts are
corroded
Aid is off
Put in new battery
Put battery in aid
correctly
Replace with right type
of battery
Check with audiologist
Turn on – often “on” can
be the switch in the
“M” position or the
battery door closed
tightly

Problems Causes Solution
“Dead”
Hearing aid
(no sound at
all) continued
Ear mold canal is
plugged with wax
Disconnected
Tubing is twisted or kinked
Tubing is plugged
Moisture is in tubing
Remove ear mold,
remove wax with wax
loop; wash w/warm
soapy water/ dry mold
using forced air blower
Push tubing firmly onto
aid
Straighten tubing
Clean tubing with a pipe
cleaner, wash and dry
with forced air blower
Use forced air blower to
dry.

Distortion of
Sound
Battery is almost dead
corroded
Ear mold canal is
plugged
Volume control is too
high or turned to
full-on
Put in new battery
Gently try to erase using
pencil eraser
Remove wax or dirt from
ear mold canal with a
wax loop and wash
ear mold
Turn down volume
control from full-on to
correct volume
setting.

Distortion of
Sound continued
Microphone opening is
dirty or covered
Moisture is in ear mold
and/or tubing
Tubing is collapsed or
twisted
Remove dirt, food, etc.
from microphone with
care and be sure
microphone is left
uncovered (sometimes
cleaning must be done
by the audiologist).
Dry ear mold and tubing
well after washing using
the forced air blower.
Untwist and open tubing

Intermittent
sound (aid goes
on and off)
Battery is almost dead
corroded
Bad volume control
switch
Moisture is in tubing
Moisture is in aid
Put in new battery
Erase contacts gently
with pencil eraser
Use forced air blower
Use dri-aid kit overnight. If
problem persists
check with
audiologist.

Feedback
(whistling)
Ear mold is not put into
ear correctly
Ear mold does not fit well
(too big or too small)
Aid not firmly attached
to ear mold
Put ear mold carefully
into ear so it fits snugly
Push ear mold or tubing
firmly together

Feedback
(whistling)
Volume control is
turned too high
Internal feedback
inside the hearing aid
case because of
defect in aid
Tubing is stiff, cracked
or has hole in it.
Turn down volume (but
not below its normal
setting)
Have tubing replaced

CRITICAL SKILLS FOR SLP’S
• Troubleshooting the hearing aid and performing a
listening check are critical skills for the SLP who
works with clients who are hard-of-hearing.
• It is also important for the SLP to perform a battery
check. Several battery testers for hearing aids are
available.
• Batteries come in a variety of sizes with the larger
batteries generally powering the larger hearing
aids.

BATTERY LIFE
• The length of battery life that a given battery has
depends on the drain of a specific hearing aid
coupled with the number of hours that the client
wears the aid each day (Mueller et al, 2007).
• The SLP should keep a battery tester with her when
working with hard-of-hearing clients as a dead
battery is a frequent culprit for a “dead” hearing
aid and the client not being able to respond to
sound.

TIPS FOR AMPLIFICATION USAGE
Keep them on during ALL hours
• Strings with a clip can attach to the hearing aids and then
you can safety pin or clip the strings to the child’s shirt
• It is critical that hearing aids are used during all waking
hours to ensure auditory access to speech and language
and environmental sounds.
• During academic classes, an FM system is most often
recommended. If the child does not use an FM system,
contact the audiologist to see if that person recommended
one.

HEARING AID TIPS
• Ensure properly functioning hearing aids
• Protect them by:
• putting “super seals” on,
• using a dry aid kit,
• cleaning the wax out on a daily basis
• Perform a listening check before you put them on
the child
• Ensure the battery is working throughout the day
(To see if the battery is functioning, cup hand over
ear and listen for feedback. This only tells status of
batteries – not function of aids.)

HEARING AID TIPS
• Keep extra batteries on hand
• Troubleshoot feedback
• Ensure mold is properly in place
• Ensure mold fits
• (The volume control cannot be turned up to the correct
level with an ill-fitting mold or it will feedback.) Use
otoferm or a similar product on the ear mold and refer for
new ear molds if the fit is too loose.
• Ensure that the volume is turned up to a range that provides
adequate hearing (Between 2 ½ - 3 on a 1- 4 volume wheel.)
Currently, most audiologists will lock a VC for kids so they
cannot adjust the volume themselves.

REFERENCES
• American Speech-Language-Hearing Association. (2001b). Knowledge and skills required for the practice of
audiologic/aural rehabilitation [Knowledge and Skills], from
www.asha.org/policy.
• American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of
Practice]. Available from www.asha.org/policy.
• American Speech Language Hearing Association. (2011). Self-test for hearing loss.http://www.asha.org/public/hearing/Self-
Test-for-Hearing-Loss/
• Archer, J., & Crosby-Quinatoa, G. (2009). Cochlear implant program: Strategies for treating children with hearing impairments
in the schools. http://www.asha.org/Events/convention/handouts/2009/1431_Archer_Jamy_Claire/
• Bentler, R.A. (1993). Amplification for the hearing impaired child. J.G. Alpiner &
P.A. McCarthy (Eds.). In Rehabilitative audiology: Children and adults,2nd ed. (pp. 115 – 160). Baltimore: Williams and Wilkins.
• Hewitt, J., Madell, J., & Rotfleisch, S. (2011). Listening to kids: Optimizing Technology
http://www.asha.org/Events/convention/handouts/2011/Hewitt-Madell-Rotfleisch/
• Mueller H.G., Johnson E.E., & Carter A.S. (2007). Hearing aids and assistive devices.
In R. Schow & M. Nerbonne (Eds.). Introduction to audiologic rehabilitation, 5th ed. (pp.31-76). Boston: Allyn and Bacon.
• Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.
• Woodford, C.M. (1987). Speech-language pathologists’ knowledge and skills
Regarding hearing aids. Language, Speech, and Hearing Services in
Schools, 18, 312-322.

PICTURE REFERENCES
• http://www.energizerasiapacific.com/products_hearing_aid_faq.aspx
• http://broadmeadhearing.com/hearing-aids/hearing-aid-styles
• http://www.ecvv.com/product/605085.html
• http://memphissoul50.com/hearing-aid-reviews-primary-facts-one-should-know/
• http://www.hopkinsmedicine.org/hearing/hearing_aids/size_style.html
• http://www.amphl.org/audiology.php
• http://hocksproducts.com/product_catalog/accessories__consumer_resale_items
• http://www.hear4youtoday.com/comersus/store/comersus_viewItem.asp?IdProdu
ct=3351
• http://www.harriscomm.com/catalog/product_info.php?products_id=16901&hcCsi
d=8
• http://www.mountainside-medical.com/products/ACU%252dLIFE-Hearing-Aid-Air-
Blower.html
• http://www.lloydhearingaid.com/shopping/accessories/multiuse.asp
• http://www.aliexpress.com/item/V-168-Sound-Enhancement-BTE-Hearing-
Aid/553190377.html

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